Category: Patient Advocacy

Lymphoma and Infection: Do I Need to Take Medication to Prevent Infection?

By Jessica Lewis, PA

In some instances, patients may be started on medicines to prevent or minimize infection. Infection in patients with impaired immune system function (due to lymphoma or treatment of lymphoma) can be life threatening. Ultimately, your doctor will determine whether to start such medications, but some current literature helps medical providers make this decision. The National Comprehensive Cancer Network (NCCN) is a not-for-profit alliance between 21 different cancer-treating centers within the USA. Research generated from physicians in these institutions is used to develop evidence-based recommendations to help guide healthcare providers. The American Society of Clinical Oncology (ASCO) is a not-for-profit group of physicians, who focus on patient-oriented clinical research, education, prevention, and delivery of patient care.

The NCCN and ASCO provide summaries of factors that predict a lymphoma patient’s risk of developing fever and infection. These factors include age, performance status, type of cancer, status of disease (remission vs. active disease), type of treatment, the presence of a low infection-fighting white blood cell count (neutropenic), and prior episodes of fever with chemotherapy treatment. Patients with lymphoma are generally classified as having intermediate risk, although some patients with CLL or T-cell lymphoma may be considered high risk.

Prevention of bacterial infections: Common prophylactic medications include levofloxacin or ciprofloxacin. Prophylaxis is recommended for intermediate or high-risk patients, including patients that are expected to have neutropenia. There have been few randomized-controlled trials that have investigated the use of antibiotics to prevent development of fever and infection in lymphoma patients that are receiving chemotherapy. The largest randomized-controlled study, by Cullen et al in 2005, included 1,565 patients with solid cancers and lymphomas treated with chemotherapy that would lower the white blood cell count.  In this study, patients were randomly assigned a placebo or levofloxacin. The authors found a decrease in the incidence of fever and decreased rates of probable infection and hospitalization. However, patients who received levofloxacin did not have a statistically significant decreased rate of severe infection (including lethal infections). As per 2012 NCCN and ASCO guidelines, the use of levofloxacin prophylaxis is only recommended for patients with neutropenia that lasts longer than 7 days.

Prevention of fungal infections: Medications to prevent fungal infections are not usually needed in lymphoma patients. ASCO guidelines recommend considering prophylaxis only for patients with profoundly low white blood cell counts (ANC <100) longer than 7 days. Additionally, patients should limit exposure to construction or demolition sites, and quit cigarette smoking to reduce risk of fungal infections.

Prevention of viral infections: Antiviral medications may be recommended. If you have been exposed to hepatitis B infection, you may be started on medication to prevent this from becoming an active infection. If you had the chicken pox as a child you are at risk of developing shingles, and you may benefit from preventative medication. Patients with lymphoma should not receive the shingles vaccine.

PCP prevention: Some patients are at risk of developing pneumonia, caused by Pneumocytus jirovecii (also referred to as PCP). You may require preventative medication, typically with TMP-SMX, if you are on steroids for a prolonged period of time (>1 month), or are receiving treatment with alemtuzumab or purine analogs (i.e., fludarabine).

Other preventative measures: ASCO 2012 guidelines recommended all patients who are receiving cancer treatment to receive the seasonal flu vaccine, along with their family and household contacts. Guidelines from the Centers for Disease Control (CDC) include administration of a pneumococcal vaccine in all patients with lymphoma.

Rally for Medical Research: Help Protect Funding for Medical Research

On April 8, 2012 thousands of individuals and nearly 200 partnering programs, including representatives from the American Society of Hematology (ASH), American Society of Clinical Oncology (ASCO), and American Association of Cancer Research (AACR) gathered at the Carnegie Library grounds in Washington, D.C. for the Rally for Medical Research. Here medical research supporters sought to raise public awareness over the importance of federally funded medical research. This need has been magnified by the March 1 sequestration mandated cuts to all areas of the federal budget, and a decade long decline in funding for the National Institute of Health (NIH).

As ASH wrote, this decline in money for medical research is not a new development:

“Research supported by the National Institutes of Health (NIH) is in serious jeopardy. NIH’s inflation-adjusted budget today is almost 20 percent lower than it was in FY 2003…Under sequestration, the NIH budget will be cut by an additional $1.6 billion over the remainder of fiscal year (FY) 2013. While the impact of these cuts may not be felt all at once or immediately, the harm caused to bio-medical research will be devastating- progress toward cures for deadly diseases and efforts to prevent costly chronic conditions will be slowed…”

Besides these  budgetary concerns, ASCO President Sandra M. Swain noted the human cost of such budget cuts, stressing the impressive strides made in cancer research due to federal funding:

“As a direct result of the federal investment in cancer research, we understand more about cancers than at any point in human history. This understanding of cancer at the molecular level has created unprecedented opportunities to slow the growth of cancer diseases. As a country, we can be proud that two of three people in the U.S. with cancer live at least 5 years after their diagnosis. This is up from one of two in the 1970s before the passage of the National Cancer Act. Since the 1990s, the nation’s cancer death rate has dropped 18 percent, reversing decades of increases. More than 13 million people in the U.S. are cancer survivors.”

Considering these new fiscal realities, the researchers and clinicians in the Lymphoma Program at Weill Cornell Medical College are adjusting accordingly. They will continue to do all that they can to deliver the latest in ground breaking research and clinical care.

Click here to use the ASH advocacy tool to contact your Representative and Senators about protecting medical research. Contact information for individual Representatives and Senators can be found here and here.

ASH Patient Advocacy Alert: Help Protect Medical Research Funding

Funding for the National Institutes of Health (NIH) is in serious jeopardy. As the American Society of Hematology (ASH) explains:

“After years of flat funding, NIH’s inflation-adjusted budget is close to 20 percent lower today than in FY2003, and, if the scheduled across-the-board cuts (known as sequestration) go into effect January 2, 2013, NIH will be subject to an 8.4 percent further cut. Thousands of NIH grants could be eliminated and cutting-edge research on blood and other diseases will be stifled.”

ASH has organized a special patient advocacy campaign so that patients can quickly and easily send a letter to their members of Congress about about the impact that inadequate funding has on the development of cures and treatments for serious diseases.

Click here to use the ASH advocacy tool to contact your representative and senators.